Managed Care Magazine Online - Wellnesshttp://managedcaremag.com/category/tags/wellness
enWellness Debate Irrelevant For Insurers Eyeing the Markethttp://managedcaremag.com/archives/2014/2/wellness-debate-irrelevant-insurers-eyeing-market
<div class="field field-name-field-slug field-type-text field-label-hidden"><div class="field-items"><div class="field-item even">Plan Watch</div></div></div><div class="field field-name-title field-type-ds field-label-hidden"><div class="field-items"><div class="field-item even"><h2>Wellness Debate Irrelevant For Insurers Eyeing the Market</h2></div></div></div><div class="field field-name-field-deck field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p>Despite last year’s fiasco at Penn State and growing concern about the effectiveness of such programs, employers are still believers</p>
</div></div></div><div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even"><p>Reports about wellness programs have occupied this space many times. Why shouldn&rsquo;t they? Employers demand, insurers supply.</p>
<p>Jaan Sidorov, MD, a consultant, former health plan medical director, and member of our editorial advisory board, says, &ldquo;It&rsquo;s a no-brainer.&rdquo; He adds, &ldquo;Employers and their employees want them. Laypersons believe that wellness programs, thanks to prevention and health promotion, should translate into lower premiums.&rdquo;</p>
<p>Yet thanks in part to last year&rsquo;s fiasco at Penn State, the benefits of wellness have been questioned. Writing in the Los Angeles Times (http://tinyurl.com/op-ed-wellness), Rahul K. Parikh, MD, asked, &ldquo;Do such programs have the intended effect of healthier employees and lower health-care costs? As more businesses embrace health incentives, these questions are becoming more urgent.&rdquo;</p>
<h4 class="subhead">Does it work?</h4>
<p>There&rsquo;s no doubt where Al Lewis stands. Lewis, the founder of the Disease Management Purchasing Consortium, says that if wellness programs were so popular with employees, then the penalties and incentives would not have doubled in the last four years.</p>
<div class="imagebundleright">
<img src="/sites/default/files/images/faces/Lewis-Al_0.jpg" alt=""/>
<p>&ldquo;Wellness programs are so worthless that employers basically have to force their employees to lose money if they don&rsquo;t participate,&rdquo; says Al Lewis, founder of the Disease Management Purchasing Consortium.</p>
</div>
<p>&ldquo;People have to be paid to do wellness,&rdquo; says Lewis. &ldquo;If something is valuable, people will pay you to do it. For example, I&rsquo;m talking to you on an iPhone. Apple did not pay me to take the iPhone off their hands; I paid Apple. Wellness programs are so worthless that employers basically have to force their employees to lose money if they don&rsquo;t participate.&rdquo;</p>
<p>Further, Lewis contends, there&rsquo;s no evidence that wellness programs work &mdash; that they actually improve outcomes. He cites a study in 2009 in Health Affairs co-written by Katherine Baicker, PhD, a professor of health economics in the department of health policy and management at the Harvard School of Public Health (http://tinyurl.com/sBaicker-article).</p>
<p>&ldquo;In the top-tier journals, there&rsquo;s been only one. Ever. One ever. That supported wellness,&rdquo; Lewis says. Baicker&rsquo;s article says that wellness can generate an ROI of 3.27:1. Lewis, who says he has a lot of respect for Baicker, also mentions that she &ldquo;walked it back&rdquo; on the NPR show Marketplace last year.</p>
<p>&ldquo;She goes on Marketplace and says, &lsquo;It&rsquo;s too early to tell; we have to keep experimenting.&rsquo;&rdquo;</p>
<p>Baicker basically corroborates this, telling Managed Care that the &ldquo;Health Affairs article includes many caveats, but of course such academic nuances are rarely reported in the popular press. Whenever I am interviewed, I try to reintroduce those cautions alongside the main results of the paper &mdash; so my comments on Marketplace mirror what we said in the paper itself.&rdquo;</p>
<p>What she said: First, there are clearly limitations in the broader generalization of these findings. Second, the companies implementing these programs are probably those with the highest expected returns. Third, it is difficult to gauge the extent of publication bias, with programs seeing high return on investment most likely to be written about and studies with significant findings of positive returns most likely to be published. Fourth, almost all of the studies were implemented by large employers, which are more likely than others to have the resources and economies of scale necessary both to implement and to achieve broad savings through employee wellness programs.</p>
<p>Lewis argues that the only ones who believe in wellness programs are those who get to sell them. &ldquo;There&rsquo;s wellness that&rsquo;s done to employees, and there&rsquo;s wellness that&rsquo;s done for employees. The Penn State program was clearly done to employees. Is it something that people like intuitively, or is it something people have to be forced into? They were definitely forced into it.&rdquo;</p>
<p>No one objects to someone losing weight, stopping smoking, or exercising more. But Lewis believes that you can&rsquo;t pay people to do those things.</p>
<p>It is especially difficult to lose weight. He calls the connection between weight and health a loose correlation.</p>
<p>&ldquo;Most of those comorbidities don&rsquo;t happen until you&rsquo;re over 65,&rdquo; says Lewis. &ldquo;Even if they do happen when you&rsquo;re under 65 &mdash; like diabetes &mdash; the actual complications and the facts that are going to cause the money to go up are over 65. So as an employer, if you&rsquo;re seeking out cases of very early stage pre-diabetes, you&rsquo;re simply going to create costs for yourself.&rdquo;</p>
<h4 class="subhead">Difficult to gauge</h4>
<p>Parikh, in his Los Angeles Times article, said, &ldquo;A number of recent studies have cast doubt on both the cost savings and the sustainability of some employee wellness programs.&rdquo;</p>
<p>One such study, Parikh wrote, showed that fewer employees were hospitalized. Money saved, right? Well, no. Those savings were offset by more visits to the doctor and use of prescription drugs.</p>
<p>For health insurers, though, this debate is academic. Randel K. Johnson, the senior vice president for labor, immigration, and employee benefits at the U.S. Chamber of Commerce, wrote an op-ed last April in The Hill with the telling headline, &ldquo;The Truth About Workplace Programs: Everybody Wins&rdquo; (http://tinyurl.com/Johnson-article).</p>
<p>&ldquo;In identifying impending and current chronic disease and illnesses, these programs offer another way to advance our country&rsquo;s health care evolving approach beyond simply treating diseases and caring for the sick to improving health and maintaining wellness. These wellness programs give people tools to identify their risk factors, improve their health, modify unhealthy behavior, and stay well both in the workplace and at home.&rdquo;</p>
<p>We circle back to Sidorov&rsquo;s point: Employers want wellness programs. He also argues that they are not as ineffectual as Lewis and others think.</p>
<p>&ldquo;I think insurers have internal numbers that have not been made public that do show a beneficial impact on utilization,&rdquo; says Sidorov. &ldquo;What&rsquo;s more, even if there isn&rsquo;t that much of a return on investment, it&rsquo;s what the market wants, and that alone qualifies as a classic loss-leader.</p>
<p>&ldquo;In addition, health plans with a reputation for strong wellness programs may benefit from stickiness with consumers who are baseline healthy and dilute the risk pool. Last but not least, health plans are, whether they like it or not, in the public spotlight and, from a brand as well as public policy perspective, need to be perceived as part of the solution.&rdquo;</p>
<p>It comes down to execution, Sidorov believes. Penn State shows how things can go wrong, but is not an indictment of wellness programs. &ldquo;I have some opinions about Penn State &mdash; charging more for nonparticipation, a school in turmoil, ultimately meritless but hot-button concerns over privacy, suspicious faculty, effective communications from a few alarmed professors, a rather ham-fisted administrative response, and the distractions that come from a national spotlight. These have more to do with execution than merit.&rdquo; </p>
</div></div></div><div class="field field-name-taxonomy-vocabulary-5 field-type-taxonomy-term-reference field-label-above"><div class="field-label">Tags:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/category/tags/wellness">Wellness</a></div></div></div><div class="field field-name-field-author field-type-text field-label-hidden"><div class="field-items"><div class="field-item even">Frank Diamond</div></div></div>Mon, 17 Feb 2014 23:08:12 +0000webadmin8799 at http://managedcaremag.comWellness Benefits Not in the Mindhttp://managedcaremag.com/archives/2013/8/wellness-benefits-not-mind
<div class="field field-name-field-slug field-type-text field-label-hidden"><div class="field-items"><div class="field-item even">News &amp; Commentary</div></div></div><div class="field field-name-title field-type-ds field-label-hidden"><div class="field-items"><div class="field-item even"><h2>Wellness Benefits Not in the Mind</h2></div></div></div><div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even"><p>Wellness is as wellness does, to coin a phrase that probably can&rsquo;t stand on its own but means in this instance that workers get out of a program what they put into it.</p>
<p>So much for the obvious. What&rsquo;s new in a study in the American Journal of Health Promotion is that the positive effects of wellness programs on mental health are negligible at best.</p>
<p>That study, &ldquo;Is Usage of a Wellness Center Associated With Improved Quality of Life?&rdquo;, says that &ldquo;a wellness center can improve physical health and has limited or no effect on maintaining mental health.&rdquo;</p>
<p>Researchers at the Mayo Clinic measured quality of life (QOL) for about 1,100 members of a wellness center from September 2008 through December 2009.</p>
<p>Even for those who used the centers the most and got the most physical benefit as a result, the mental health benefits were practically non-existent, and they actually declined for those who used the centers the least, from 51.4% to 34.5%.</p>
<p>The authors have some suggestions.</p>
<p>&ldquo;The benefits of physical activity are well established, but perhaps to fully affect mental QOL, wellness centers need to offer a wide range of strategies for spirituality, stress reduction, sleep, social support, relationships, career advancement, and financial planning.&rdquo;</p>
</div></div></div><div class="field field-name-taxonomy-vocabulary-5 field-type-taxonomy-term-reference field-label-above"><div class="field-label">Tags:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/category/tags/wellness">Wellness</a></div></div></div>Sat, 17 Aug 2013 20:21:44 +0000webadmin8638 at http://managedcaremag.comLarge employers agree on rewarding healthy behaviorhttp://managedcaremag.com/archives/1304/1304.outlook.html
<div class="field field-name-field-slug field-type-text field-label-hidden"><div class="field-items"><div class="field-item even">Managed Care Outlook</div></div></div><div class="field field-name-title field-type-ds field-label-hidden"><div class="field-items"><div class="field-item even"><h2>Large employers agree on rewarding healthy behavior</h2></div></div></div><div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even"><p>Large employers plan to continue offering health coverage to workers, according to the 18th annual Towers Watson/National Business Group on Health Employer Survey, but the struggle to minimize costs continues. This year, the survey looks at how this challenge is taken up by employers that, of the 583 respondents, &ldquo;are in the top tier of respondents whose costs have increased over four years at a much lower rate than the &hellip; median.&rdquo;</p>
<table border="1" cellpadding="4">
<tbody>
<tr>
<th colspan="2">Companies that have controlled health costs well now plan to &hellip;</th>
</tr>
<tr>
<td>Examine health care benefits, employee subsidies, and out-of-pocket costs in a &ldquo;total rewards&rdquo; framework</td>
<td>39%</td>
</tr>
<tr>
<td>Manage company subsidy as part of a &ldquo;total rewards&rdquo; budget rather than a separate health plan budget</td>
<td>30%</td>
</tr>
<tr>
<td>Increase employee contributions in tiers, with dependent coverage at higher rate than single coverage</td>
<td>24%</td>
</tr>
<tr>
<td>Structure employee contributions based on employees taking specific actions</td>
<td>23%</td>
</tr>
<tr>
<td>Adopt new payment methodologies that hold providers accountable for the cost of episodes of care, replacing fee for service</td>
<td>22%</td>
</tr>
<tr>
<td>Offer telemedicine for professional consultations</td>
<td>22%</td>
</tr>
<tr>
<td>Fund account-based health plans in accord with wellness or health management behavior</td>
<td>22%</td>
</tr>
<tr>
<td>Offer specialty provider networks</td>
<td>20%</td>
</tr>
<tr>
<td>Track outcomes quantitatively from all vendors</td>
<td>20%</td>
</tr>
<tr>
<td>Contract directly with physicians, hospitals, and/or ACOs</td>
<td>18%</td>
</tr>
<tr>
<td>Provide access to a private or corporate health exchange</td>
<td>18%</td>
</tr>
</tbody>
</table>
<p>&ldquo;The actions of our best performers may well provide a playbook that others can follow to achieve their goals,&rdquo; the study says. &ldquo;This is especially true for those whose strategies and tactics have led to less-than-desirable financial and health results.&rdquo;</p>
<p>One thing the most successful companies are doing is &ldquo;integrating their contribution strategy with their health management and wellness activities. Many more companies are tying their wellness incentive strategy to their [account-based health plan] contributions.&rdquo;</p>
<p>More employers are not just taking the workers&rsquo; word for it regarding whether they&rsquo;re making necessary lifestyle adjustments.</p>
<p>&ldquo;More recently, companies have been expanding biometric outcomes to include achievement of specific body mass index levels and target cholesterol levels. Today, 16 percent of companies align their rewards/penalties with specific biometric targets (other than tobacco use), and another 31 percent are considering this strategy for 2014.&rdquo;</p>
<table border="1" cellpadding="4">
<tbody>
<tr>
<th colspan="5">
Wellness incentives to expand; requirements to be tougher
</th>
</tr>
<tr>
<td>
<p/>
</td>
<td>2011</td>
<td>2012</td>
<td>2013</td>
<td>2014</td>
</tr>
<tr>
<td>Use financial rewards for people who participate in health management programs/activities</td>
<td>54%</td>
<td>61%</td>
<td>62%</td>
<td>81%</td>
</tr>
<tr>
<td>Use penalties for people not completing requirements of health management programs/activities</td>
<td>19%</td>
<td>20%</td>
<td>18%</td>
<td>36%</td>
</tr>
<tr>
<td>Require employees to complete a health risk appraisal and/or a biometric screening to be eligible for financial incentives</td>
<td>35%</td>
<td>42%</td>
<td>54%</td>
<td>75%</td>
</tr>
<tr>
<td>Require employees to validate participation in healthy lifestyle activities to receive a reward or avoid a penalty (e.g., proof of fitness center use or engagement with a primary nurse case manager)</td>
<td>_</td>
<td>23%</td>
<td>33%</td>
<td>59%</td>
</tr>
<tr>
<td>Reward or penalize based on tobacco use</td>
<td>30%</td>
<td>35%</td>
<td>42%</td>
<td>62%</td>
</tr>
<tr>
<td>Reward or penalize based on biometric outcomes such as achievement of weight control or target cholesterol levels</td>
<td>12%</td>
<td>10%</td>
<td>16%</td>
<td>47%</td>
</tr>
<tr>
<td>Apply rewards or penalties and/or requirements under health management programs/activities to employees and spouses alike</td>
<td>19%</td>
<td>23%</td>
<td>31%</td>
<td>59%</td>
</tr>
</tbody>
</table>
<p class="sourceline">Source: &ldquo;Reshaping Health Care: Best Performers Leading the Way,&rdquo; Towers Watson/National Business Group on Health, March 2013</p>
</div></div></div><div class="field field-name-taxonomy-vocabulary-5 field-type-taxonomy-term-reference field-label-above"><div class="field-label">Tags:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/category/tags/wellness">Wellness</a></div></div></div>Fri, 03 May 2013 02:04:59 +0000webadmin8500 at http://managedcaremag.comKaiser Permanente Goes All Out To Provide Access to Wellnesshttp://managedcaremag.com/archives/1303/1303.planwatch.html
<div class="field field-name-field-slug field-type-text field-label-hidden"><div class="field-items"><div class="field-item even">Plan Watch</div></div></div><div class="field field-name-title field-type-ds field-label-hidden"><div class="field-items"><div class="field-item even"><h2>Kaiser Permanente Goes All Out To Provide Access to Wellness</h2></div></div></div><div class="field field-name-field-deck field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p>The insurer studies exactly what works and why in studying two programs that battle diabetes</p>
</div></div></div><div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even"><p>Usually studies stir interest when they&rsquo;re finished, not when they&rsquo;re started. That&rsquo;s not the case with Kaiser Permanente Northern California Division&rsquo;s plan to review two recently launched diabetes programs. Employers have historically been behind wellness efforts, but Kaiser&rsquo;s endeavors indicate that more insurer-based programs may be on the way.</p>
<p>&ldquo;If our studies show that wellness coaching has a positive impact on health and wellness outcomes, then an important question will be, &lsquo;How can we get members who might most benefit from these programs to engage with them?&rsquo;&rdquo; says Julie Schmittdiel, PhD, a research scientist at the Kaiser Permanente Northern California Division of Research. &ldquo;So testing different methods of outreach to see what works best will be an important way to address a key question for employers and health plans.&rdquo;</p>
<p class="photocaption"><img src="/sites/default/files/imported/1303/Julie_Schmidttdiel.jpg" alt="" style="float:right;padding-left:10px;" />&ldquo;Our wellness efforts have been proven effective in a number of rigorous evaluations,&rdquo; says Julie Schmittdiel, PhD, a research scientist at the Kaiser Permanente Northern California Division of Research.</p>
<p>Schmittdiel is the lead author of an article in the January Preventing Chronic Disease, a publication by the Centers for Disease Control &amp; Prevention. (&ldquo;Health-Plan and Employer-Based Wellness Programs to Reduce Diabetes Risk: The Kaiser Permanente Northern California NEXT-D Study,&rdquo; <a href="http://tinyurl.com/Kaiser-Diabetes-Study">http://tinyurl.com/Kaiser-Diabetes-Study</a>. NEXT-D stands for Natural Experiments in Translation for Diabetes.) That article outlines how she and her team plan to study two of Kaiser Permanente&rsquo;s antidiabetes efforts.</p>
<p>&ldquo;The two [programs] described in our article are both still in process,&rdquo; says Schmittdiel.</p>
<h4 class="subhead">Active role</h4>
<p>Her article says that health plans and providers are starting to offer wellness programs, often health education and lifestyle programs.</p>
<p>That insurers undertake this effort is a relatively new development. Al Lewis, founder and president of the Disease Management Purchasing Consortium, points out that &ldquo;The first health plan to put wellness in a request-for-proposals for outsourced services was Carefirst in 2006.&rdquo; Carefirst is a Blues plan in Maryland.</p>
<p>One of the programs measured by Schmittdiel uses telephone coaching and motivational interviewing to encourage lifestyle changes. The other targets women with gestational diabetes mellitus, offering postpartum glucose screening and diabetes prevention education.</p>
<p>&ldquo;Gestational diabetes is one of the biggest risk factors for developing type 2 diabetes in young women,&rdquo; says Schmittdiel. &ldquo;Two to 10 percent of pregnant women will develop gestational diabetes, and women with gestational diabetes are seven times more likely to develop type II diabetes later. Reducing this risk is a critical women&rsquo;s health issue and diabetes prevention issue.&rdquo;</p>
<h4 class="subhead">Three phases</h4>
<p>She adds that she hopes to publish the results of the coaching and gestational diabetes projects this year.</p>
<p>Schmittdiel divides her effort into three phases, the first two focusing on about 1,400 beneficiaries who participated in the insurer&rsquo;s wellness coaching program from January through August 2011.</p>
<p>Phase 1 is a survey of patient satisfaction, and their reasons for using the wellness coaching program, self-reported changes in healthy behaviors, and patient engagement. The coaching program looks at healthy eating, physical activity, stress management, smoking cessation, and weight control.</p>
<p>Phase 2 involves observing control groups at different times both before and after the intervention to assess the effect of wellness coaching on levels of BMI, systolic blood pressure, and low-density lipoprotein cholesterol levels.</p>
<p>If researchers determine that the coaching has helped, then phase 3 will compare the effectiveness of three outreach methods (letters, interactive voice&ndash;response telephone messages, and secure e-mail) on about 30,000 patients with prediabetes.</p>
<h4 class="subhead">Skepticism</h4>
<p>The reviews have not all been positive. The health care blogger Vik Khanna, MHS, for instance, sees little that is really new in Kaiser Permanente&rsquo;s efforts (<a href="http://tinyurl.com/Vik-Comment">http://tinyurl.com/Vik-Comment</a>.)</p>
<p>Khanna is a consultant whose background includes a stint at the Johns Hopkins University Bloomberg School of Hygiene and Public Health. He is admittedly a hard man to please when it comes to wellness programs.</p>
<p>On his Web site, he notes that he at one time designed corporate wellness programs for both large and small companies.</p>
<p>&ldquo;These experiences have proven both enlightening and discouraging,&rdquo; Khanna writes. &ldquo;Notably, my experience has taught me that the corporate wellness industry, now valued at about $6 billion, really is just a fiction. For all the claims made by industry vendors, there are few data points about programmatic success that can withstand even modest scrutiny. Hence, my philosophical shift from industry acolyte to industry heretic. The corporate wellness industry isn&rsquo;t saving anyone a dime.&rdquo;</p>
<h4 class="subhead">What wellness should not be</h4>
<p>Khanna calls Kaiser Permanente&rsquo;s effort a &ldquo;perfect example of what wellness should not be.... This is just managed care all dressed up to seem like something bright, shiny, and new. The study participants are obese (i.e., at least one risk factor and probably multiple ones have already emerged) and were given one-on-one coaching. In other words, they were treated with a conventional medical model. And there is almost zero chance of ever returning these people to a state of risk-free good health.&rdquo;</p>
<p>Lewis, while not commenting on Kaiser&rsquo;s efforts specifically, also has some doubts. The entire wellness industry, he says, is &ldquo;made up.&rdquo;</p>
<p>Schmittdiel responds that &ldquo;while wellness programs have their detractors, that has not been the experience at Kaiser Permanente. Our wellness efforts have been proven effective in a number of rigorous evaluations. The current study seeks to quantify what is working with our diabetes prevention programs so that we can provide improved access to them for our members.&rdquo;</p>
<h4 class="subhead">Timely</h4>
<p>Schmittdiel adds that the studies are particularly timely in an age of health reform that emphasizes accountable care organizations and patient-centered medical homes.</p>
<p>&ldquo;We believe that these changes in the U.S. health care system will continue to place a strong emphasis on efforts to improve the level of care integration and also emphasize accountability for prevention and wellness,&rdquo; she says.</p>
<p>Besides, employers like wellness programs and want to understand the best approaches, and are also looking for programs that get workers to participate in programs that will improve their health. </p>
</div></div></div><div class="field field-name-taxonomy-vocabulary-5 field-type-taxonomy-term-reference field-label-above"><div class="field-label">Tags:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/category/tags/wellness">Wellness</a></div></div></div><div class="field field-name-field-author field-type-text field-label-hidden"><div class="field-items"><div class="field-item even">Frank Diamond</div></div></div>Sun, 14 Apr 2013 20:24:19 +0000webadmin8487 at http://managedcaremag.comDefining Nondiscriminatory Wellness Programs Remains a Work in Progresshttp://managedcaremag.com/content/defining-nondiscriminatory-wellness-programs-remains-work-progress
<div class="field field-name-title field-type-ds field-label-hidden"><div class="field-items"><div class="field-item even"><h2 class="blog-title">Defining Nondiscriminatory Wellness Programs Remains a Work in Progress</h2></div></div></div><div class="field field-name-display-name-for-blog field-type-ds field-label-hidden"><div class="field-items"><div class="field-item even">Paul Terry</div></div></div><div class="field field-name-field-blog-author-photo field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><img src="http://managedcaremag.com/sites/default/files/styles/blog_author_image_right/public/blogauthors/Paul_Terry-circle-160x160.jpg?itok=3nuVluJA" width="160" height="150" alt="" /></div></div></div><div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even"><p>The Department of Labor has issued new guidelines concerning the wellness provisions of the Affordable Care Act (ACA) that relate to the use of financial incentives, and the <em>Office of Health Plan Standards and Compliance Assistance</em> is seeking public comment. This document proposes “amendments to regulations, consistent with the Affordable Care Act, regarding nondiscriminatory wellness programs in group health coverage." These regulations increase rewards for wellness participation or outcomes from 20 to 30% or up to 50% related to reducing tobacco use. (<a href="https://www.federalregister.gov/articles/2012/11/26/2012-28361/incentives-for-nondiscriminatory-wellness-programs-in-group-health-plans">Federal register</a>)</p>
<p>In the past several years, StayWell Health Management has published several studies concerning the use of financial incentives in wellness programs, so my colleagues, Drs. David Anderson, David Gregg, and I, felt obliged to offer some reactions to the proposed new language. All public comments will be posted at: <a href="http://www.dol.gov/ebsa/">http://www.dol.gov/ebsa/</a>. By way of summary, we commended the department for its painstakingly earnest attempt to placate the detractors of the original proposal who believe that incentives could too readily become a subterfuge for insurance underwriting. Still, we believe their attempt to divide incentives into participation based or health contingent models may well shed more heat than light on the matter.</p>
<p><strong>Proposed regulations</strong></p>
<p>The proposed regulations regarding a health-contingent wellness program include a provision that appears to say members must be offered the total reward even when they have no medical condition that would make it unreasonably difficult to meet the health standard or medically inadvisable to attempt to do so, based solely on meeting a participation-based alternative standard. StayWell believes this effectively negates any substantive programmatic difference between a participation-based and health-contingent wellness program. Participation in a wellness program by an individual is, in effect, a default option for anyone who is not inclined to make an effort at even making reasonable progress toward the standard, much less achieve it. In effect, the health-contingent wellness program is fundamentally a participation-based program with a provision that allows an employer to waive the participation requirement for individuals who already meet the health standard. </p>
<p>Conversely, we believe a health-contingent wellness program should be clearly differentiated from an essentially participation-based approach by establishing a <a href="http://www.ajhpcontents.org/doi/pdf/10.4278/ajhp.26.1.c2">progress-based alternative standard</a> for those who do not meet the health standard but are not granted a waiver because it would be unreasonably difficult to meet the health standard during the time allotted or medically inadvisable to attempt to do so. We believe the progress-based alternative standard should be individually tailored and supported by a health coach working under medical supervision to ensure that the progress-based goal aligns with health guidelines and does not pose increased risk to the individual.</p>
<p><strong>Health Enhancement Research Organization</strong></p>
<p>StayWell collaborated with the Health Enhancement Research Organization, often known as HERO, along with the American College of Occupational and Environmental Medicine; the American Cancer Society and the American Cancer Action Network; the American Diabetes Association, and the American Heart Association to bring together the views and concerns of the consumer (in this case the employee) and of the employer as represented by our member organizations. Through a collegial process, we added our support to developing a <a href="http://www.acoem.org/uploadedFiles/Public_Affairs/Policies_And_Position_Statements/JOEM%20Joint%20Consensus%20Statement.pdf">joint consensus statement on designing employer-sponsored wellness programs</a> using outcomes-based incentives, which provides guidance to employers either considering or embarked on providing health-centric wellness programs regarding what should be considered in their plan.</p>
<p>StayWell concurs with much of what the HERO organization offered by way of response to the Department of Labor; that a worksite wellness program should be tailored to achieve improved health outcomes for individuals and populations.</p>
<p>Our industry experience to date indicates that in some organizations, an opportunity to receive a lower premium tied to a health factor standard, so long as it is not overly burdensome, may be an incentive to change behavior. In other organizations, however, some premium differential designs may have unintended consequences, such as deterring certain high-risk individuals or groups from engaging in programs. The dearth of evidence about the potential effect of these new ACA regulations makes a one-size-fits-all approach premature. Furthermore, because there is limited research in this area, any policy-setting approach is unsubstantiated at best. Accordingly, we will continue to urge transparency and data sharing in our professional network to identify and promulgate best practices.</p>
<p><strong>Organizational culture</strong></p>
<p>As importantly, our research has shown that incentives work best when bolstered by an organizational culture that makes healthy choices the easy choices for employees. Dan Buettner, a scholar who has researched longevity worldwide, summarized the vital role of culture nicely in an article in the <em>New York Times Magazine</em> titled, <a href="http://www.nytimes.com/2012/10/28/magazine/the-island-where-people-forget-to-die.html?pagewanted=all&amp;_r=0"><em>The Island Where People Forget to Die</em></a>.</p>
<p>Buettner wrote: “For people to adopt a healthful lifestyle, I have become convinced, they need to live in an ecosystem, so to speak, that makes it possible. As soon as you take culture, belonging, purpose or religion out of the picture, the foundation for long healthy lives collapses. The power of such an environment lies in the mutually reinforcing relationships among lots of small nudges and default choices.”</p>
<p>
<em>Paul E. Terry, PhD, is CEO of<a href="http://staywellhealthmanagement.com/"> StayWell Health Management</a></em></p>
</div></div></div>Tue, 05 Feb 2013 14:38:17 +0000Paul Terry8423 at http://managedcaremag.comEmployers told to measure wellness ROIhttp://managedcaremag.com/archives/1211/1211.news_wellnessroi.html
<div class="field field-name-field-slug field-type-text field-label-hidden"><div class="field-items"><div class="field-item even">News &amp; Commentary</div></div></div><div class="field field-name-title field-type-ds field-label-hidden"><div class="field-items"><div class="field-item even"><h2>Employers told to measure wellness ROI</h2></div></div></div><div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even"><p>Companies that make the effort to find out what they are saving with their wellness programs are often pleasantly surprised, says a study by the International Foundation of Employee Benefit Plans. The IFEBP, a not-for-profit group that studies benefit plans, surveyed 447 member organizations, finding that about 1 in 5 analyzes ROI and of them, 4 in 5 achieve positive results. A significant number show a savings of $3 for every $1 spent.</p>
<p>&ldquo;Attaching plan design incentives to participation was the most frequently cited reason&rdquo; given by responding organizations for achieving positive ROI. The largest differences in participation rates between companies that offer program participation incentives and those that do not occur with health screenings (33 vs. 57 percent) and health risk assessments (33 vs. 55 percent).</p>
<h4 class="charthead">Effect of incentives on average participation rate</h4>
<div>
<img src="/sites/default/files/imported/1211/1211.news_wellnessroi_fig1.png" alt="" style="max-width:100%;" />
</div>
<p class="sourceline">Source: &ldquo;A Closer Look: Wellness ROI,&rdquo; International Foundation of Employee Benefit Plans</p>
</div></div></div><div class="field field-name-taxonomy-vocabulary-5 field-type-taxonomy-term-reference field-label-above"><div class="field-label">Tags:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/category/tags/wellness">Wellness</a></div></div></div>Mon, 26 Nov 2012 21:20:23 +0000webadmin8370 at http://managedcaremag.comBiometrics now part of wellness mixhttp://managedcaremag.com/archives/1210/1210.news_biometrics.html
<div class="field field-name-field-slug field-type-text field-label-hidden"><div class="field-items"><div class="field-item even">News &amp; Commentary</div></div></div><div class="field field-name-title field-type-ds field-label-hidden"><div class="field-items"><div class="field-item even"><h2>Biometrics now part of wellness mix</h2></div></div></div><div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even"><p>&ldquo;What do you want from me? Blood?&rdquo; So goes the oft-thought but rarely voiced employee complaint. Well, more employers have actually begun taking employee blood to integrate biometric information into wellness programs by measuring such things as cholesterol and body mass index.&ldquo; Nine percent of large firms that ask employees to complete a health risk assessment (HRA) report that employees are rewarded or penalized financially based on whether they meet specified biometric outcomes, such as meeting a target body mass index or cholesterol level,&rdquo; says a study by the Kaiser Family Foundation and the Health Research &amp; Educational Trust. (Smoking cessation is not one of the targets.)</p>
<p>In addition, 11 percent of large companies (200 or more employees) say that they require an employee at risk to complete a wellness program to avoid a financial penalty such as higher premium contribution or more cost-sharing.</p>
<div>
<h4 class="charthead">Some large companies offer rewards or slap penalties based on wellness</h4>
<img src="/sites/default/files/imported/1210/1210.news_penalties_fig1.png" alt="" style="max-width:100%;">
</div>
<p class="sourceline">Source: The Kaiser Family Foundation, and the Health Research &amp; Educational Trust</p>
</div></div></div><div class="field field-name-taxonomy-vocabulary-5 field-type-taxonomy-term-reference field-label-above"><div class="field-label">Tags:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/category/tags/wellness">Wellness</a></div></div></div>Mon, 29 Oct 2012 19:59:57 +0000webadmin8337 at http://managedcaremag.comMore emphasis on wellnesshttp://managedcaremag.com/archives/1209/1209.news_wellness_chart.html
<div class="field field-name-field-slug field-type-text field-label-hidden"><div class="field-items"><div class="field-item even">News &amp; Commentary</div></div></div><div class="field field-name-title field-type-ds field-label-hidden"><div class="field-items"><div class="field-item even"><h2>More emphasis on wellness</h2></div></div></div><div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even"><p>Employers &ldquo;plan to sharply increase the incentive amount for maintaining a healthy lifestyle or participating in a wellness program,&rdquo; according to a survey by the National Business Group on Health.</p>
<p>Companies know full well that the Affordable Care Act changes the minimum amount an employer can deduct from premiums under HIPAA from 20 to 30 percent.</p>
<p>Kevin Volpp, MD, PhD, director of the Center for Health Incentives and Behavioral Economics at the Leonard Davis Institute, pointed out to us in March (<a href="http://preview.tinyurl.com/employer-incentives">http://preview.tinyurl.com/employer-incentives</a>) that Section 2705 of the Affordable Care Act says that, &ldquo;beginning in 2014, an employer may use 30 percent of an employee&rsquo;s premium for outcome-based wellness incentives (and 50 percent in some cases, if the government approves).&rdquo;</p>
<p>&ldquo;They can say you are going to pay $10,000 a year, but if your body mass index is less than X, you don&rsquo;t smoke, you have a low LDL cholesterol and a well-controlled blood pressure, you are going to pay $7,000 a year,&rdquo; says Volpp. &ldquo;This will change the current model considerably if employers start doing this.&rdquo;</p>
<h4 class="subhead">When the HIPAA-allowed wellness incentive limit increases from 20% to 30% of total plan costs for an individual in 2014, do you expect to increase your incentives beyond the current 20 percent limit?</h4>
<p><img src="/sites/default/files/imported/1209/1209.news_fig1.png" alt="" style="max-width:100%;"></p>
<h4 class="subhead">What are the 3 most effective steps you have taken or will take to control health care cost increases?</h4>
<p><img src="/sites/default/files/imported/1209/1209.news_fig2.png" alt="" style="max-width:100%;"></p>
<p class="sourceline">Source: National Business Group on Health, &ldquo;Large Employers&rsquo; 2013 Health Plan Design Survey,&rdquo; August 2012no periods in source lines</p>
</div></div></div><div class="field field-name-taxonomy-vocabulary-5 field-type-taxonomy-term-reference field-label-above"><div class="field-label">Tags:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/category/tags/wellness">Wellness</a></div></div></div>Mon, 01 Oct 2012 02:15:36 +0000webadmin8330 at http://managedcaremag.comForever Younghttp://managedcaremag.com/content/forever-young
<div class="field field-name-title field-type-ds field-label-hidden"><div class="field-items"><div class="field-item even"><h2 class="blog-title">Forever Young</h2></div></div></div><div class="field field-name-display-name-for-blog field-type-ds field-label-hidden"><div class="field-items"><div class="field-item even">Steven Peskin, MD</div></div></div><div class="field field-name-field-blog-author-photo field-type-image field-label-hidden"><div class="field-items"><div class="field-item even"><img src="http://managedcaremag.com/sites/default/files/styles/blog_author_image_right/public/blogauthors/dr_peskin_160x160_3.jpg?itok=TRyICu1b" width="160" height="160" alt="" /></div></div></div><div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even"><p>As a baby boomer moving through middle age into the unspeakable age that follows “middle,” I was encouraged to read an article in the <em>British Medical Journa</em>l that states that for seniors and super seniors, healthy behaviors that include regular exercise, not smoking, maintaining a normal Body Mass Index, and having a rich or moderate social network led to significant increases in longevity. From the study:</p>
<p>“Even after age 75 lifestyle behaviours such as not smoking and physical activity are associated with longer survival," the study authors write. "A low risk profile can add five years to women's lives and six years to men's. These associations, although attenuated, were also present among the oldest old (≥85 years) and in people with chronic conditions."</p>
<p>This study affirms the benefits of lifestyle and healthy behaviors for the hundreds of millions of people who are in or are entering their golden years in the United States and across the industrialized world. With these “prescriptions” or interventions, there is no need for elaborate quality-adjusted life year studies or comparative-effectiveness research to justify hundred-thousand-dollar sickness care interventions! The ROI is compelling.</p>
<p>Shaping or modifying our own personal behaviors or effecting positive health behaviors in others, whether as a health plan, an employer, or as clinicians, is no piece of cake but is well worth the effort.</p>
<p><em>Steven R. Peskin, MD, MBA, FACP, is associate clinical professor of medicine at the University of Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical School.</em></p>
</div></div></div>Fri, 21 Sep 2012 16:05:23 +0000Steven Peskin MD8320 at http://managedcaremag.comTufts Offers Its Workers Short Commute to Carehttp://managedcaremag.com/archives/1207/1207.planwatch.html
<div class="field field-name-field-slug field-type-text field-label-hidden"><div class="field-items"><div class="field-item even">Plan Watch</div></div></div><div class="field field-name-title field-type-ds field-label-hidden"><div class="field-items"><div class="field-item even"><h2>Tufts Offers Its Workers Short Commute to Care</h2></div></div></div><div class="field field-name-field-deck field-type-text-long field-label-hidden"><div class="field-items"><div class="field-item even"><p>Though ROI is hard to calculate, insurer says that its on-site clinics are changing employee behavior for the good</p>
</div></div></div><div class="field field-name-body field-type-text-with-summary field-label-hidden"><div class="field-items"><div class="field-item even"><h3 class="deck">Though ROI is hard to calculate, insurer says that its on-site clinics are changing employee behavior for the good</h3>
<p class="author">Frank Diamond</p>
<p><span class="inline inline-left"><img src="/sites/default/files/images/faces/LydiaGreene.jpg" alt="Lydia Greene" title="Lydia Greene" class="image image-thumbnail " width="160" height="240" /></span>When Tufts Health Plan opened its Be Well Center for its own employees in February, it did so as a self-insured company, the kind that tends to rely more on clinics than those that aren&rsquo;t self-insured. Tufts wasn&rsquo;t doing a pilot test of a product to be sold. It has no plan to offer these clinics to employer sponsors or insured companies, says Lydia Greene, vice president for human resources and diversity.</p>
<h4 class="subhead">Wellness culture</h4>
<p>In this case, Tufts is just one of many companies focusing more on wellness, as was noted in last year&rsquo;s study of 588 companies by the National Business Group on Health and Towers Watson, which says that 23 percent offer wellness services and another 12 percent plan to begin offering them this year.</p>
<p>The Be Well Center, which is managed by Take Care Health Systems, a subsidiary of Walgreens, is available to 1,700 Tufts employees on the company&rsquo;s Watertown, Mass., campus. Be Well complements the insurer&rsquo;s Working Well Center, a fitness facility that offers classes in nutrition, exercise, yoga, acupuncture, and massage. The Working Well Center, also managed by Take Care, offers 35 classes a week and costs employees $28 a month. The Be Well Center is staffed by a nurse practitioner, a medical assistant, and a wellness coach, and there&rsquo;s a local PCP who oversees the operation.</p>
<p>Improving productivity and overall workforce satisfaction are goals. The Tufts wellness program began about seven years ago as part of a broad company culture change. &ldquo;For each of the last three years the annual increase in health benefit costs has been under 3 percent,&rdquo; says Greene. Yet she concedes that &ldquo;determining ROI can be challenging.&rdquo;</p>
<p>The Center for Studying Health System Change has addressed workplace clinics, saying, &ldquo;Employers need to be realistic about return on investment, and that measurement poses challenges.&rdquo; The study, &ldquo;Workplace Clinics: A Sign of Growing Employer Interest in Wellness,&rdquo; says that while some experts argue that clinics can achieve a positive ROI in the first year, most don&rsquo;t expect to break even for at least two years, possibly longer. It doesn&rsquo;t help that there are no industry standards for measurement. &ldquo;Two types of ROI are typically estimated: &lsquo;hard ROI,&rsquo; which measures savings in direct medical costs only, and &lsquo;soft ROI,&rsquo; which also includes productivity gains from such factors as reduced absenteeism,&rdquo; says the study.</p>
<p>Greene says, &ldquo;What we do know is wellness programs can improve employee morale, and that&rsquo;s always a welcome ROI.&rdquo;</p>
<p>For instance, Tufts aims for that most daunting of wellness goals: long-term, sustainable weight loss. That&rsquo;s where the Be Well and Working Well centers work hand in hand. &ldquo;We have a full-time wellness coach in the Be Well Center,&rdquo; says Greene. &ldquo;She helps identify and overcome whatever obstacles to wellness might be present in a person&rsquo;s life. She can refer you to our on-site nutritionist or she can give you a free pass to the gym for a couple of months. Close to 50 percent of the individuals who choose coaching over a three- to six-month period are focused on weight loss.&rdquo;</p>
<h4 class="subhead">Endless battle</h4>
<p>For years the gym had about 125 members. In the last four years, that&rsquo;s grown to more than 500, nearly a third of the campus population.</p>
<p>&ldquo;I would have been pretty skeptical about this four or five years ago,&rdquo; says Greene. &ldquo;But my experience here has made a believer out of me. When you change the culture and make it comfortable for an overweight person to be in a gym or participate in a cycling class, you make it accessible and acceptable as a workplace practice.&rdquo; </p></div></div></div><div class="field field-name-taxonomy-vocabulary-5 field-type-taxonomy-term-reference field-label-above"><div class="field-label">Tags:&nbsp;</div><div class="field-items"><div class="field-item even"><a href="/category/tags/wellness">Wellness</a></div></div></div><div class="field field-name-field-author field-type-text field-label-hidden"><div class="field-items"><div class="field-item even">Frank Diamond</div></div></div>Sat, 28 Jul 2012 12:20:30 +0000webadmin8061 at http://managedcaremag.com